Dialectical Behavior Therapy for People with ID/DD Presented by: APS Healthcare Southwestern PA Health Care Quality Unit

1. Dialectical Behavior Therapy for People with ID/DDPresented by: APS HealthcareSouthwestern PA Health Care Quality Unit(HCQU) December 2010 bjl

2. Disclaimer Information or education provided by the HCQU is not intended to replace medical advice from the consumer’s personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented. Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies.

3. Note of Clarification While mental retardation (MR) is still recognized as a clinical diagnosis, in an effort to support the work of self-advocates, the APS SW PA HCQU will be using the terms intellectual and/or developmental disability (ID/DD) to replace mental retardation (MR) when feasible.

4. Objectives Define Dialectical Behavior Therapy (DBT) Recall stages of DBT Identify benefits and challenges of DBT for people with ID/DD List DBT strategies for staff

5. What is Dialectical Behavior Therapy? Originally developed for borderline personality disorder Can be applied to other mental health disorders Aims to teach emotional regulation and stress tolerance skills

6. Origins of DBT Developed by Dr. Marsha Linehan in 1991 Designed to address ‘emotional dysregulation’

7. Origins of DBT: Emotional Dysregulation Biological causes Genetics Intrauterine factors Traumatic events in early brain development

8. Origins of DBT: Emotional Dysregulation Environmental Factors Invalidating environment Feelings, responses, and experiences disqualified Self-control and self-reliance highly valued Genuine emotions/reactions seen as ‘untrue’ or ‘inaccurate’

9. Origins of DBT Similar to Cognitive Behavioral Therapy But with some differences Teaches emotional regulation skills and stress tolerance Emphasizes validation and change

10. DBT Theory of Borderline Personality Disorder People react abnormally to emotional stimulation Emotional arousal increases faster, peaks higher, and takes longer to return to baseline Invalidating environments hinder development of basic coping/regulation skills

11. Main Goals of DBT Regulate extreme emotions Individuals learn to trust emotions, thoughts, behaviors Reduce negative behaviors Help individuals create ‘lives worth living’

12. How DBT Works Teaching new skills and improving existing skills Increase use of healthy responses and techniques Treatment organized into 4 stages

13. DBT - Stage One “Moving from being out of control of one’s behavior into being in control” Targets/Goals for this stage: Decreasing suicidal behaviors/thoughts Decreasing behaviors that interfere with therapy Decreasing behaviors that reduce quality of life Learning new skills to deal with emotions and relationships

14. DBT – Stage Two “Moving from being emotionally shut down to experiencing emotions fully.” Targets/Goals for this stage: Learning healthy coping skills Learning additional skills to deal with emotions

15. DBT – Stage Three “Building an ordinary life, solving life problems’ Targets/Goals include: Working on ordinary problems (job/relationship issues, career goals, etc.) Focusing on what makes a person’s life worth living

16. DBT – Stage Four “Moving from incompleteness to completeness / connection” Targets/Goals include: Seeking meaning in one’s life Spiritual/religious fulfillment Seeking new career paths/learning new skills/seeking new relationships

17. DBT and Group Therapy Group therapy important in DBT treatment Weekly sessions to augment individual therapy Offers individuals chance to practice skills with others

18. Effectiveness of DBT Research shows effectiveness in reducing: Self-injurious behaviors In-patient psychiatric hospitalizations Extreme and uncontrolled anger

19. Other Uses of DBT Drug dependence Male prison inmates Binge eating disorder Depression In older adults Also in teenagers

20. DBT for People with ID/DD What makes DBT viable for those with ID/DD? Biological vulnerability Invalidating environments

21. Benefits of DBT for People with ID/DD A ‘skills-based’ treatment Does not label individuals Teaches individuals to ‘self-advocate’ Based on concrete ideas / practices

22. Challenges of DBT for People with ID/DD Cognitive-based treatment Requires support from agency administration Some individuals may not be ready for certain aspects of treatment

23. Challenges of DBT for People with ID/DD ISPs may become more difficult to create Skills practice must take place in ‘real world’

24. Benefits of DBT for Treatment Teams All staff members have input Treatment is team oriented Aids in problem-solving Team members model behaviors for individuals

25. DBT Strategies for Staff Validation Acknowledge individual’s difficult times/experiences Re-state things from individual’s viewpoint Dialectics Validate individual’s feelings and reinforce that harmful behavior is unacceptable Acknowledge individual’s reality and reality of the ‘big picture’

26. DBT Strategies for Staff - Dialectics Give praise/positive feedback for healthy behaviors Remind individual that dangerous or disruptive behaviors will not help Ask individual to come up with healthier ways of meeting needs

27. DBT Strategies for Staff Radical Acceptance Helps foster empathy Recognizing that things may be tough right now Strategizing ways to get through hard times

28. DBT – The Last Word Why use DBT for those with ID/DD? Ask instead “Why should anyone be denied a potentially helpful treatment?” What use is it for staff? DBT provides staff more tools to use Has a broad range of applications Works well with a Positive Approaches outlook

29. Suggested Trainings Borderline Personality Disorder

30. References Behavioral Tech. (2010). Dbt resources: what is dbt? Retrieved from http://behavioraltech.org/resources/whatisdbt.cfm Dykstra, E.J., & Charlton, M. (2003). Dialectical behavior therapy: a new direction in psychotherapy. Retrieved from http://www.nctsnet.org/nctsn_assets/pdfs/reports/dialectical_behavior_therapy_dykstra_charlton.pdf Huffman, J.C., Stern, T.A., Harley, R.M., & Lundy, N.A. (2003). The use of dbt skills in the treatment of difficult patients in the general hospital. Psychosomatics, 44 (5), 421-429.

31. References Lew, M., Matta, C., Tripp-Tebo, C., & Watts, D. (2005). DBT for individuals with intellectual disabilities: a program description. Retrieved from http://www.thebridgecm.org/UserFiles/Documents/DBT%20and%20ID%20May%202005.pdf Linehan, M. (2003). Dialectical behavior therapy (dbt) for borderline personality disorder. Retrieved from http://www.dbtselfhelp.com/html/dbt_for_bpd.html

32. To register for future trainings,orfor more information on this or any other physical or behavioral health topic, please visit our website at www.hcqu.apshealthcare.com

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35. Test ReviewThere will be a test review after all tests have beencompleted and turned in to the Instructor.